Health officials in turmoil over 11th-hour backflip on aged care algorithm override powers, emails reveal

Senior department of health officials were in turmoil before the rollout of an algorithm to determine funding packages for older Australians, after discovering legislation had been drafted so rigidly that the tool could not legally be overridden by aged care assessors.

Emails published under freedom of information (FoI) by the department of health, disability and ageing show that, despite assessors long receiving reassurance from the department that they would have powers to change incorrect algorithm decisions, officials realised at the 11th hour this would violate proposed regulations.

It prompted an emergency briefing of the aged care minister Sam Rae and health minister Mark Butler just three days before the rollout of the algorithm. In an email, they were warned by senior department staff that removing the human override function from the aged care assessment tool for support at home (SaH) packages carried risk.

In the email sent on 29 October, three days before the 1 November algorithm rollout, the ministers were told: “There is a risk that this late change in messaging to assessment organisations may not filter through to assessor behaviour.

“In public statements, including responses to media enquiries, the department has regularly indicated that there will be an ability for assessors to override the … classification algorithm recommendation. In accordance with this position, an override functionality has been built into the relevant systems.”

However, the ministers were told the Aged Care Rules 2025 legislation had been drafted in a way that provided “no legal discretion for assessors or assessment delegates to override the recommendation of the algorithm for a SaH classification”.

It meant the manual for using the algorithm and the assessment tool it was part of – known as the Integrated Assessment Tool (IAT) – needed to be updated ahead of the rollout to make it clear to assessors that they could not override outcomes.

“Assessment organisations (including state and territory governments) or individual assessors may criticise this position as being inconsistent with previous government statements,” the email said.

The IAT involves an assessor asking an older person questions about their physical, social and personal circumstances before the algorithm uses this data to determine how much government-funded home support and funding they are eligible to receive.

The algorithmic decision cannot be overridden by the assessor even if they believe the older person has been allocated a lower level of support than needed.

On 24 October an assistant secretary at the department, Rachel Blackwood, wrote to deputy secretary of aged care Greg Pugh about the legal issues that had come to light around allowing assessors to override the algorithm.

The Aged Care Rules 2025 “have been drafted to provide no discretion for assessors or assessment delegates to do anything other than accept the recommendation of the SaH algorithm,” her email said.

Blackwood wrote that the department had “consistently indicated that assessment delegates would have the discretion to use their clinical judgement to override the recommendation of the SaH algorithm”.

“It is clear that the inclusion of an override has been regarded by many staff … as a settled position.”

She presented a list of solutions and risks, all of which were redacted in the FoI documents. On 26 October, Pugh responded that the solution he had chosen “… may not be your preferred approach”.

“However I am comfortable that this decision is the best available in light of all contextual circumstances, including proximity to 1 November and having a clear and workable pathway to address it,” he wrote. “A big thanks for working through this tricky issue and for providing your frank and open advice.”

On 27 October, Blackwood wrote to Pugh: “We have been working hard to build credibility with assessment organisations and other stakeholders, and want to avoid doing things that will undermine our working relationship at a critical time.

“We have a responsibility to provide guidance to delegates to exercise their powers with integrity, accuracy and honesty,” she wrote.

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It is unclear why the department chose to remove assessor override from the instruction manual, rather than change the legislation to allow override. The department of health did not respond to requests for comment.

Within days of the algorithm rollout, Blackwood was emailing other senior department officials to say complaints were coming in from distressed assessors that the algorithm was routinely under-assessing vulnerable older Australians, leaving them without adequate support.

In an email to senior department staff sent on 20 November Blackwood wrote; “The majority of Aged Care Needs Assessment Organisations (including State and Territory Governments) have raised concerns about the inability to override the IAT classification algorithm”.

“Assessment organisations have provided details of cases in which assessors believe the algorithm has generated an outcome that does not align with client needs,” she wrote.

Separate documents released to Guardian Australia under FoI show state health officials were keeping logs of hundreds of cases of underassessment, sending these to their federal counterparts.

“Approving classifications and assessment outcomes that they [aged care assessors] do not agree with does not align with their professional ethics and they are concerned this has possible legal impacts,” one of those emails, sent on 14 November, said.

Guardian Australia previously reported that people already on support packages who needed reassessment because their needs had increased were routinely being recommended for lower support packages by the algorithm.

FoI documents also reveal that when the department discovered the tool was under-assessing people despite the government’s public promises and policy that older Australians would be “no worse off” under the aged care reforms, a workaround was implemented.

When an aged care assessor clicked “accept” on the algorithm’s downgraded package recommendation, the portal temporarily kept the client’s old package dollar amount active while quietly logging a lower clinical classification on their permanent record, the documents show.

The shadow aged care minister, Anne Ruston, said the Coalition had introduced legislation to restore human decision-making to the assessment process and accused Labor from blocking it.

She described it as “a practical, overdue fix that has passed the Senate but remains blocked by Labor from even being debated in the House”.

Ruston said while restoring the override was necessary, it was nowhere near sufficient on its own to fix an aged care system she described as “broken”.

Do you know more? melissa.davey@theguardian.com